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Get the Most Out of Your Health Insurance

Thank you for joining us for this edition of Thought and Action. I’ll be joined by Nicole Stewart, an insurance agent with HealthMarkets. It is not your typical insurance. We’re not talking about life insurance or property and casualty insurance. We’re talking about legitimate health insurance for your family. And this is one of those areas where I don’t know that people are aware you are paying the same price, whether or not you work with someone.

 The thought for the day is, are you maximizing your coverage? Are you legitimately getting what you pay for? And the action is if you’re not, find out, which is talk to a broker or talk to a professional about it and get the coverage that you need, because at the end of the day, like I said, you’re paying for it anyway. So go for it, get what you need and find someone you can trust so that you can legitimately change it year over year as your situation changes or the plans change.



HealthMarkets is a national brokerage where we help individuals find insurance solutions, whether they’re in the under 65 market, the Medicare market, life insurance and even group health insurance.

Since HealthMarkets is looking at everybody, every state, what their options are from a health insurance standpoint, how many options are there?

Hundreds, depending on the state. Some states have state exchanges. Others are on the federally funded marketplace.The amount of options is what makes it so overwhelming. 

Did the Affordable Care Act broadened the scope of what was going on or did it narrow it? How did it impact things?

Well, the Affordable Care Act, what it really did was it divided insurance into two categories. Sometimes we call it public and private. Sometimes it’s qualified and non-qualified. And that just means that some of the qualified plans are following all the regulations of the Affordable Care Act. And the non-qualified plans doesn’t mean it’s not good, they just don’t follow the regulation of the ACA.

So everything is really bifurcated. There’s a lot of options. And then you step in and what do you typically do? What’s the process?


HealthMarket Process

We start with a full needs analysis. We sit down with our clients. We talk about what they currently have and what they are looking to have. We look at their individual situations, whether that’s their typical medical costs, their prescription costs, how much they use the doctor or don’t. A lot of different factors go into it. But we sit down, we talk about the budget. Obviously, budget is a huge, important part of it all.

We help them create a plan and a solution that is going to be affordable for them. Not only affordable on a monthly basis, but affordable on a daily basis if they need to go to the doctor as well if something major happens.


Is there a cost for HealthMarket services? 

All of our services are completely free. It doesn’t cost the client anything. You don’t pay a higher cost for using a broker. The insurance cost is determined by the Department of Insurance. Our services are free. There’s no reason you shouldn’t use a broker. We’re going to give you a breakdown of the pros and the cons of the options and help you make a decision that is very objective.

This being a crucial point, one of the most misunderstood areas of people’s plan is health care. Health isn’t something you can really plan for. Your situation can change. I may have children. My children may have matriculated away. I may have drug costs. I may have my own business now. I may be in a public company. All of those situations change the coverage that you should have and being able to navigate hundreds of different plans on your own is very daunting because the plans also change. 

Plans change a little bit from year to year. So that’s why you really do need to look at it every year. We tell all our clients it takes an hour a year to sit down and look at one of the most important things in your financial portfolio, your health insurance. It can cost you a lot of extra money if you make some of the wrong choices.

So, again, for any broker the cost is free. The cost of the plan doesn’t change and regardless of using a broker, you’ll pay that insurance plan cost. Brokers get paid on the back end by the insurance companies, so it’s free service to all the clients.


Public vs. Private Markets

With public and private markets, how do your services apply? Does it apply to both?

As brokers, we can work on and off the market. Again, there’s no fee for either service on either side, but that’s the advantage of using a broker. We have access to, usually, all the plans that are available in that state. As HealthMarkets agents, we have a certain reputation that we uphold. We only use reputable carriers. So you’re not going to get any kind of  dodgy insurance, but you will have access to things that you might not even have known were available.

A lot of people don’t know about non-qualified plans, and those are great options for people who are very healthy. They don’t take any expensive medications and they might go to the doctor once or twice a year. They can save themselves a lot of money by switching to a non-qualified plan.

In full disclosure, since you’ve helped me with my own insurance, I think I save around six thousand dollars a year, maybe more. I think it’s five or six hundred dollars a month by switching over. And I would have never known that it was even an option because I just figured, he’s got to go with whatever publicly is there. It’s extremely valuable. I’ve seen the benefit of it.

You can help transcend the public/private divide and get into what the situation is. As mentioned, starting with that situation analysis and then building out whatever is the most beneficial, affordable option for people.

As we discussed, plans change every year. Someone might need surgery and then you need to make a change to your plan. Or somebody is going to have a baby or whatever it might be. All of those little life events and things make big differences. So, it does help to look at it every year. 


Group Insurance

Right now, do you also help with this kind of business, like if someone owns a business and you’re trying to construct the HealthMarkets for the actual business, health insurance as well? Or is it only personal?

HealthMarkets does group insurance. I just don’t do a lot of it. It’s not where my passion lies. I like to help small business owners. I like to help individuals. I don’t know. That’s just sort of how it started for me and I kind of went down that road and that’s what I’m a lot more passionate about. I like really meeting people. I’m a people person. 

I think that’s a good delineator too, is when you’re going in, you kind of want to ask and make sure the person that you’re working with really has a passion for whatever it is that you have a need for. Obviously you’re in there with the personal let’s get into the nitty gritty of it. But if you need somebody, I’m sure you bring someone that is very versed in the corporate side.

I have a bunch of people that I work with that don’t do any individual plans. They only do group insurance. I do the individual. We send each other business. It’s a win win. I know that they’re going to be helped properly and in good hands and vice versa.

I think it’s great. And again, the cost is the cost.


Making A Plan

There’s really no benefit in doing it on your own. Get a professional to overlook it and get the proper kind of coverage and advice. It brings me to the question that kind of comes up the most. This question comes up a lot in terms of health insurance in general. It’s part of our process of Family Fortune to make sure everybody has a defined plan and a professional they work with that helps them dial it in as part of our team.

But the one time of everyone’s life that I think you really have to circle on your calendar is the transition to retirement, but specifically, really 65 years old. With the transition to Medicare, if you don’t look at it on that 65th birthday, you cost yourself a lot in terms of money because the more time you wait, the more expensive that transition can be. Can you just talk through what that looks like from your standpoint as people hit that age 65 and how you really know some of the nuances that are really specific to that particular date?


Medicare Transition

With our clients, we start putting the Medicare bug in their ear at about 63, mentioning things like, “Are you going to work past 65?” “What’s your vision?” “How do you see this going as we approach 65? When we get much closer to that milestone, certainly three months prior to their 65th birthday month, we are in full Medicare mode.

Are they continuing on a group plan? Are they stopping their work? They need to have some sort of decision made because certain steps need to be put into place. Let’s just say the average person is going to stop working on their 65th birth month, three months prior, they need to apply for part A and B, a lot of people don’t know that. You need to apply for it.

It takes time to process that application anywhere from three to eight weeks. Certain things with Medicare are timestamped. So you need to have proper prescription coverage. You need to enroll at the right enrollment periods. The enrollment window when you’re initially turning 65 is three months prior to your birth month, your birth month, and then three months after. If you miss that window, that seven month window, there’s definitely some knock on effects, knock on effects with enrollment timing, but also product selection.

Certain products are guaranteed within that initial enrollment period.

So what if you’re still working? What if you love your job and you’re not planning on retiring until you’re 70 years old? Say your 65th birthday comes across. Is it still important for them to engage at that point?

Yeah, it is. Just so that you have a plan. Sometimes people think that they’re going to be working until 70 and things change. But if you are going to be working till 70, you at least want to know, if you’re going to be on a corporate plan or some sort of other health insurance plan, you don’t have to get your part B. You can delay your part B, sometimes people don’t know that.

So even though they have group coverage, they get their part B, then there’s sort of double dipping. They’re paying for the Part B side, but they’re also paying for their corporate coverage.


Medicare Coverage

Medicare coverage has two parts. Part A is your inpatient hospital services. Part B is your doctor and medical services. Any doctor, doctor’s office specialists, even doctors within a hospital. Then we have part C, which is the same thing as Medicare Advantage. And lastly, there is Part D, your prescription drug coverage. There is also Medicare supplement which is an add on to the original Medicare.

If that just confused you, you need to talk to a broker. And to be clear, HealthMarkets isn’t the only broker out there. There’s a lot of brokerages out there. This isn’t a plug for HealthMarkets. This is a plug for you getting advice from a good qualified professional. That’s the whole point, because, again, there’s not many things I can say are free and valuable, but this is free and valuable. Well, I shouldn’t say it’s free, you’re already paying for it, so you might as well get what you paid for it.


What You Need to Know 

What’s one thing that, no matter how old someone is, they should look at when the time comes for them to sign up for medical insurance in this coming year?

I would say the thing that I see over and over that impacts people heavily is drug costs. A lot of times people are a little complacent with it. But it actually is one thing that you can control. For example, on the Medicare side of prescription drug cards can range in prices. Sometimes taking a more expensive drug card can give you better coverage on your medications. That is one reason to look at your duge coverage. 

The same thing applies in the under 65 market. Sometimes people just want the best, the premium, but they forget to look at the drug costs. Typically bronze plans, they have higher drug cost pricing as opposed to silver or gold. So if you’re on expensive medications, it would behoove you greatly to maybe upgrade your plan so that you can actually save on your prescription costs.

We just had someone take a look at that and do a full analysis, and they also saved thousands just in the drug costs. Trying to filter through the hundreds of options, they found one and they ended up saving, I think, four or five thousand dollars a year.

So everybody, look at your drug costs and look at the cost of your plan. And if you don’t understand the quiz that we just had on parts A, B, C and D, definitely give yourself a moment to talk to someone for an hour. 

Well, that said, thank you very much, Nicole. It was super informative and I look forward to talking to you soon.




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